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Clinical Practice Guideline: Hoarseness (Dysphonia) (Update) Executive Summary
Robert J Stachler1, David O Francis2, Seth R Schwartz3
11 Wayne State University, Detroit, Michigan, USA.
Summary
This guideline offers evidence-based recommendations for diagnosing and treating dysphonia (voice problems). It emphasizes prompt laryngeal evaluation for specific risk factors and advocates for voice therapy, surgery, or botulinum toxin injections when appropriate.
Area of Science:
- Otolaryngology-Head and Neck Surgery
- Speech-Language Pathology
- Laryngology
Background:
- Dysphonia, affecting nearly one-third of the population, is characterized by altered vocal quality, pitch, loudness, or effort, impairing communication and quality of life.
- This guideline addresses the diagnosis and management of dysphonia across all age groups, intended for clinicians involved in patient care.
Purpose of the Study:
- To enhance the quality of care for patients with dysphonia through evidence-based recommendations.
- To reduce inappropriate variations in care, optimize health outcomes, and minimize harm associated with dysphonia treatment.
- To provide transparent, expert-guided recommendations, explicitly stating when expert consensus fills evidence gaps.
Main Methods:
- A multidisciplinary panel, including specialists and a consumer advocate, reviewed current evidence.
- Key action statements (KASs) were developed based on evidence, with strong recommendations and standard recommendations outlined.
- The guideline update incorporated new evidence, updated existing KASs, and introduced new ones, including an algorithm for patient management.
Main Results:
- Strong recommendations include assessing patients for expedited laryngeal evaluation based on risk factors and advocating for voice therapy when appropriate.
- Recommendations cover identifying dysphonia, comprehensive assessment, timely laryngoscopy, and considering surgery or botulinum toxin injections for specific conditions.
- Strong recommendations against routine antibiotic prescription and against non-visualized imaging (CT/MRI) or empiric medication (reflux, corticosteroids) for isolated dysphonia were made.
Conclusions:
- The guideline provides a framework for optimal dysphonia management, emphasizing accurate diagnosis and tailored treatment.
- It advocates for prompt laryngeal visualization and discourages unnecessary or unproven interventions.
- The updated guideline aims to improve patient outcomes and reduce healthcare costs by standardizing care for dysphonia.
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